School of Public Health and Community Medicine
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Transcript of School of Public Health and Community Medicine
School of Public Health and Community Medicine
Consulting in General PracticeWhat is happening in the consulting room?
Dr Michael TamGP and Lecturer in Primary Care
Aim
To equip you with the skills to understand the patient-doctor
interactions that you will observe in general
practice.
Learning outcomes
At the end of this learning activity, you should be able to: Compare and contrast general practice care
with hospital care Describe the process of a general practice
consultation Explain the components of the patient-
centred method
Differences: GP vs hospital consultations
1. Form small groups of 3-6 students2. Each group must have at least one
computer/tablet3. Choose a scribe4. Open the URL:
http://tiny.cc/gptask
Compare and contrast general practice care with hospital care
Small group activity
Differences: summary list
Patterns and severity of illness Casemix predictive value of
history, signs, tests Earlier presentations
undifferentiated and vague clinical features
Constraints Time Access to services Costs
Scope of care Preventive care, public and
population health Organisational role Whole-person care
Patient involvement in care Process for interventions Importance of the patient-doctor
alliance
Compare and contrast general practice care with hospital care
Differences: summary list
Continuity of care Depth of relationship Management of ongoing
problems
Use of time Longitudinal and multi-visit
nature of consultations Use of time as diagnostic and
management tool
Management versus diagnosis Pathophysiologic diagnosis may
not be necessary “Rule out” versus “rule in”
Use of follow up “Safety-netting” Prioritising health issues Proactive chronic disease care
Compare and contrast general practice care with hospital care
What is covered in a primary care consultation?
Describe the process of a general practice consultation
Stott NCH, Davis RH. The exceptional potential in each primary care consultation. Journal of the Royal College of General Practitioners 1979; 29: 201-205
Management of presenting problems
Management ofContinuing problems
Opportunistic health promotion
Modification of health seeking behaviour
Agendas
Describe the process of a general practice consultation
Doctor’s agenda Patient’s agenda
Middleton JF. The exceptional potential of the consultation revisited. Journal of the Royal College of General Practitioners 1989; 39: 383-386
Negotiated plan
The patient-centred method
Explain the components of the patient-centred method
Stewart M, Brown JB, et al. Figure 1.1. In: Patient-centred medicine: transforming the clinical method, 2nd ed. Oxon, UK: Radcliffe Medical Press, 2003.
Further learning – for those who want adeeper understanding
Read the web article “Consultation Analysis” on the Patient.co.uk website: http://www.patient.co.uk/doctor/Consultation-Analysis.htm
David Pendleton et al. developed seven basic “tasks” of the consultation.
1. Explain how these seven tasks can be mapped to the patient-centred method model developed by Stewart et al.
2. Analyse one of your GP supervisor’s consultations with a patient with complex care needs.
Explain the components of the patient-centred method
Aim revisited
To equip you with the skills to understand the patient-doctor
interactions that you will observe in general
practice.
References
Middleton JF. The exceptional potential of the consultation revisited. Journal of the Royal College of General Practitioners 1989; 39: 383-386
Stott NCH, Davis RH. The exceptional potential in each primary care consultation. Journal of the Royal College of General Practitioners 1979; 29: 201-205
Stewart M, Brown JB, et al. Patient-centred medicine: transforming the clinical method, 2nd ed. Oxon, UK: Radcliffe Medical Press, 2003.
Draper R. Consultation analysis [website]. Updated 2010 Feb 19 (Retrieved 2014 Jan 12). Available from: http://www.patient.co.uk/doctor/Consultation-Analysis.htm